BACKGROUND:
Conventional perinatal care often centers on biomedical definitions of risk, prioritizing neonatal outcomes and adherence to clinical protocols. Yet individuals with breech pregnancies may define safety more broadly, emphasizing autonomy, dignity, and relational care. There is limited research on how those who decline planned cesarean assess and navigate risk.

OBJECTIVES:
To explore how individuals with term breech pregnancies conceptualize safety and assess risk when choosing birth options that diverge from medical recommendations, including planned home birth.

METHODS:
We conducted a qualitative study using interpretive description informed by situational analysis. Participants (n=25) were U.S.-based women with a term breech pregnancy who initially planned a hospital birth but chose to pursue a planned breech birth at home. Data were generated through open-ended surveys and in-depth, semi-structured interviews.

RESULTS:
Participants defined safety through a multidimensional lens that extended beyond biomedical outcomes. Three key themes emerged: upholding autonomy and personal values, safeguarding holistic health and well-being, and ensuring respectful, high-quality care. Participants described feeling at risk in hospital settings due to coercive counseling, lack of skilled breech providers, restrictive protocols, and previous trauma. In contrast, home birth was often perceived as safer because it aligned with participants’ values, offered continuity and relational trust, and protected bodily autonomy and dignity. Despite trade-offs, decisions were viewed as informed, deliberate, and grounded in a broader understanding of safety.

CONCLUSIONS:
Participants’ definitions of safety reflected individualized assessments shaped by experience, values, and systemic barriers. These findings underscore the need to expand definitions of perinatal safety and ensure care models that support autonomy, relational trust, and informed choice across all birth settings.

KEY MESSAGE:
To provide truly person-centered care, midwives must engage with each individual’s own understanding of safety. This requires not only offering skilled, respectful care that supports autonomy and informed choice, but also recognizing and working to address the systemic barriers that constrain those choices. Complications - decision making